In my last article on acne, I discussed about its cause and its clinical features. Here, I will be talking about the treatment options that are available for acne. Now, the treatment for acne is mainly aimed at decreasing the bacterial population which is present in the hair follicles. Drugs which promote the shedding of horny plugs that obstruct the hair follicles are also used. Such drugs are known as comedolytic agents. Excessive production of sebum is one of the main features of acne and thus treatment is also aimed at reducing its production.
Patients suffering from acne often become depressed and thus need moral support and counseling. There are few general rules that these patients must follow. They should always keep their skin clean. Face should be cleaned using a mild soap or face wash. Hair should be tied in a way that it does not touch the face and forehead. Pillows, bed sheets which come in contact with the face should be kept clean. Also, one should never touch the inflamed skin with fingers. It can lead to further infection. The use of cosmetics should be kept to minimal. Any oil based cosmetic should never be applied. One should reduce the consumption of nuts, chocolates, cocoa and fatty meat. Any form of stress should also be avoided.
After these general rules, let’s discuss the main drugs which are being used to treat acne. The preferred treatment is the topical treatment (local application). Systemic drugs are not used too often nowadays. The various topical preparations which are being used are creams, gels or lotions. The advent of retinoids revolutionized the acne therapy. These drugs encourage the shedding of the horny plugs which are responsible for obstruction of the hair follicles. The retinoids used commonly are- Tretinoin, Isotretinoin and Adapalene. They usually have very less side effects.
Few antibiotics are also used topically like Erythromycin (1-2 percent) and Clindamycin (2 percent). These drugs are quite effective especially in treating mild and moderate forms of acne. Tetracycline can also be used locally but is not as effective as the other antibiotics. Sulphur was once a popular drug for treating acne but is not being used much now.
Systemic treatment is required if the local treatment isn’t enough or acne is too severe. But these might be prescribed in the beginning of therapy also. Tetracyclines have long been used systemically for treating acne. The principal antibiotic is Oxytetracycline. Minocycline is used if the response to Oxytetracycline is not good enough. These drugs are usually given for a period of two to three months. However treatment might have to be maintained for several months or even longer. Diarrhoea and gastrointestinal upset can occur with long term consumption of tetracyclines. Erythromycin is also equally effective when used systemically. Both these antibiotics are usually started in a dose of 250mg and the dose is reduced after few weeks if the response is good.
If a patient does not respond to any of the topical and systemic drugs given above, then Isoretinoin is used systemically. It acts on the sebaceous glands and decrease the sebum production. It is usually given for a period of four months. The problem with this drug is that there are way too many side effects. It can harm the liver, bone and can also increase the lipid levels in the blood.
Last but not the least; anti-androgens are also used for treating acne. They inhibit sebum secretion. One of the anti-androgen which is being used is Dianette. Spironolactone which is actually a diuretic is also occasionally used for treatment of acne. However these drugs are not too popular and are used only as the last resort!
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